Healthcare Provider Details

I. General information

NPI: 1972932929
Provider Name (Legal Business Name): TRACY SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2013
Last Update Date: 11/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 SMITH TER
BEDFORD TX
76021-2239
US

IV. Provider business mailing address

629 SMITH TER
BEDFORD TX
76021-2239
US

V. Phone/Fax

Practice location:
  • Phone: 817-455-7481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number65272
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: